Graham R A, Hohn D C
Department of General Surgery, University of Texas, M. D. Anderson Cancer Center, Houston 77030.
Dis Colon Rectum. 1990 Mar;33(3):212-6. doi: 10.1007/BF02134182.
Forty patients with inguinal lymph node metastases from rectal adenocarcinoma were reviewed. Patients were divided into three groups based on the extent of their disease: (1) patients with unresectable primary tumors; (2) patients with recurrent disease after abdominoperineal resection; and (3) patients with isolated inguinal lymph node metastases after abdominoperineal resection. Patients in Groups 1 and 2 underwent biopsy of their nodal metastases. Patients in Group 3 were treated by inguinal node dissection. Survival data were examined for each group, and four clinical and pathologic features were analyzed to determine their impact on prognosis: depth of invasion of the primary tumor (T1-2 vs. T3-4), number of positive lymph nodes in the rectal specimen (0-2 vs. greater than 2), extent of the inguinal lymph node metastases (unilateral vs. bilateral), and timing of the inguinal lymph node metastases (less than 1 vs. greater than 1 year after abdominoperineal resection). There were no five-year survivors in any group. Median survival was highest in those with isolated lymph node metastases, with 2 patients remaining free of disease, and was lowest in those with unresectable primary disease (7 months). Median survival was increased when inguinal LNM were unilateral (17 vs. 6 months; P less than 0.01) and when they occurred more than 1 year after abdominoperineal resection (21 vs. 7 months; P = 0.02). Stage of the primary lesion (depth of invasion and number of positive lymph nodes) did not affect survival. Of the 32 patients who underwent biopsy alone, only 1 developed a tumor-related groin complication. For patients with isolated inguinal lymph node metastases, inguinal node dissection is recommended for the purposes of local control and possible cure. For patients with extranodal disease, prophylactic excision of inguinal lymph node metastases is not warranted.
对40例直肠腺癌腹股沟淋巴结转移患者进行了回顾性研究。根据疾病程度将患者分为三组：（1）原发性肿瘤无法切除的患者；（2）经腹会阴切除术后复发的患者；（3）经腹会阴切除术后孤立性腹股沟淋巴结转移的患者。第1组和第2组患者对其淋巴结转移灶进行了活检。第3组患者接受了腹股沟淋巴结清扫术。检查了每组的生存数据，并分析了四个临床和病理特征以确定它们对预后的影响：原发性肿瘤的浸润深度（T1-2与T3-4）、直肠标本中阳性淋巴结的数量（0-2与大于2）、腹股沟淋巴结转移的范围（单侧与双侧）以及腹股沟淋巴结转移的时间（经腹会阴切除术后少于1年与大于1年）。任何一组均无5年生存者。孤立性淋巴结转移患者的中位生存期最高，有2例患者无疾病复发，原发性疾病无法切除的患者中位生存期最低（7个月）。腹股沟淋巴结转移为单侧时中位生存期延长（17个月对6个月；P<0.01），且在经腹会阴切除术后1年以上发生时中位生存期延长（21个月对7个月；P=0.02）。原发性病变的分期（浸润深度和阳性淋巴结数量）不影响生存。在仅接受活检的32例患者中，只有1例出现了与肿瘤相关的腹股沟并发症。对于孤立性腹股沟淋巴结转移的患者，建议进行腹股沟淋巴结清扫以实现局部控制并可能治愈。对于有结外疾病的患者，不建议预防性切除腹股沟淋巴结转移灶。
